Elemam Elsayed, Abdelbaser Ibrahim, Abdelfattah Mahmoud, Eisa Ahmed Amin, Moursi Ahmed Gamal, Abd Allah Mohamed Y Yousef, Alaidy Ahmed, Elsharkawy Reem Abdelraouf, Farid Ahmed, Ramzy Eiad, Elkenany Samah, Habeeb Tarek, Sabry Ramy, Tharwat Mohamed, Badr May Elsherbiny
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
J Cardiothorac Vasc Anesth. 2025 Mar;39(3):742-749. doi: 10.1053/j.jvca.2024.09.134. Epub 2024 Sep 24.
This study compared the postoperative analgesic efficacy of serratus anterior plane block (SAPB) and thoracic paravertebral block (PVB) in children undergoing video-assisted thoracoscopic surgery.
Operating room and intensive care unit of a tertiary care hospital.
A single-center, randomized, comparative, open-labeled study.
Seventy pediatric patients aged 2 to 10 years who underwent video-assisted thoracoscopic surgery were enrolled.
Patients were equally randomized into 2 groups. In the SAPB group, patients were injected with 0.4 mL/kg 0.25% bupivacaine under ultrasound guidance into the deep SAPB and in the PVB group, patients were injected with 0.4 mL/kg 0.25% bupivacaine under ultrasound guidance into the thoracic paravertebral space.
The primary outcome was morphine consumption within the first 24 hours after surgery. The secondary outcomes were Children's Hospital of Eastern Ontario Pain Scale pain score, intraoperative fentanyl consumption, and the time required to perform the block. The median (Q1, Q3) morphine consumption (mg/kg) in the first postoperative 24 hours was similar in the SAPB and PVB groups (0.15 [0.1-0.2], 0.1 [0.1-0.2], respectively). The Children's Hospital of Eastern Ontario Pain Scale pain score was similar in both the SAPB and PVB groups at all-time points. Intraoperative fentanyl consumption was comparable in both groups. Time needed to perform the block was shorter in SAPB than PVB.
SAPB provides effective postoperative pain control, similar to thoracic PVB. Moreover, it is technically easier and has a shorter time to perform than PVB. Therefore, SAPB is an effective and safe alternative to thoracic PVB.
本研究比较了前锯肌平面阻滞（SAPB）和胸椎旁神经阻滞（PVB）在接受电视辅助胸腔镜手术儿童中的术后镇痛效果。
一家三级护理医院的手术室和重症监护病房。
一项单中心、随机、对比、开放标签研究。
纳入70例年龄在2至10岁接受电视辅助胸腔镜手术的儿科患者。
患者被随机分为两组。在SAPB组，患者在超声引导下向深层前锯肌平面注射0.4 mL/kg 0.25%布比卡因；在PVB组，患者在超声引导下向胸椎旁间隙注射0.4 mL/kg 0.25%布比卡因。
主要结局指标为术后24小时内吗啡用量。次要结局指标为东安大略儿童医院疼痛量表疼痛评分、术中芬太尼用量以及实施阻滞所需时间。术后24小时内，SAPB组和PVB组吗啡用量中位数（四分位数间距）（mg/kg）相似（分别为0.15 [0.1 - 0.2]和0.1 [0.1 - 0.2]）。在所有时间点，SAPB组和PVB组的东安大略儿童医院疼痛量表疼痛评分相似。两组术中芬太尼用量相当。SAPB组实施阻滞所需时间比PVB组短。
SAPB与胸椎PVB一样能提供有效的术后疼痛控制。此外，与PVB相比，其技术操作更简便，实施时间更短。因此，SAPB是胸椎PVB一种有效且安全的替代方法。
